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The effect of the WIC program on food security status of pregnant, first-time participants.

Article Excerpt
The literature on household food security in the United States has grown substantially in recent years, at least partially due to the availability since 1995 of a standardized instrument for assessing this phenomenon in the population (Hamilton et al., 1997). The food security status of participants in the Food Stamp Program (Gundersen & Oliveira, 2001; Perez-Escamilla et al., 2000), the Expanded Food and Nutrition Education Program (EFNEP) (Greer & Poling, 2001), and welfare programs (Borjas, 2001; Capps, Ku, & Fix, 2002; Winship & Jencks, 2001) has been investigated. There have been only a few studies on the influence of the effect of the U.S. Department of Agriculture's (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on food security status. A Florida study found that participation in WIC and the number of different income sources were the two factors most highly associated with more weekly family food servings and improved food security (Taren, Clark, Chernesky, & Quirk, 1990). A large improvement in diet quality, and therefore indirectly food security, was demonstrated in an analysis of data from the 1989-91 Continuing Survey of Food Intakes by Individuals (1989-91 CSFII) that examined the relationship between WIC participation and dietary intake. Participation in the WIC Program by at least one family member was shown to raise the aggregate household Healthy Eating Index (HEI) score by 23.45 points in a sample of 1,438 WIC participants, compared with households that did not participate in the WIC Program (Basiotis, Kramer-LeBlanc, & Kennedy, 1998).

The underlying premise of WIC is that low income predisposes individuals to poor nutritional status and poor health outcomes during critical periods of growth and development. The program is not designed as a safety net to guard against food insecurity or hunger but rather as a targeted intervention to protect the most vulnerable members of the population--namely, pregnant women with increased nutritional needs, as well as infants and children--from the effects of these phenomena. Although income eligibility is set at 185 percent of the Federal poverty level, most participants live in households with incomes at or below the poverty line. The WIC population also includes a high proportion of ethnic minorities--subgroups found to have the highest rates of food insecurity nationally (Nord, Andrews, & Carlson, 2002). In 2001, the WIC Program served about 7.3 million participants each month (USDA, 2001) and provided cash grants totaling $4.1 billion to 88 State agencies (USDA, 2000).

In the Institute of Medicine's (IOM) 1996 report evaluating WIC nutrition risk criteria, it was suggested for the first time that food insecurity be used as a risk criterion for program eligibility. A subsequent report (Institute of Medicine, 2002) evaluating dietary assessment in the WIC Program recognized the significance of food insecurity as a potential contributor to nutritional risk and the likely benefit from participation in the WIC Program. However, the report did not offer specific recommendations about food insecurity because of lack of sufficient evidence on which to select a cutoff point to identify those most likely to benefit.

In addition to referrals for social services, the WIC Program offers participants a supplemental food package tailored to participants' nutritional needs. The food package for pregnant clients has a value of nearly $70 per month and contains foods that are suitable for consumption by all family members. Items include juice, cereal, eggs, milk and cheese, and a choice of beans or peanut butter. The package for the postpartum period is similar but has smaller quantities of these items and is worth about $60. This package may also include canned tuna and fresh carrots for women who choose to breastfeed or infant formula for women who choose not to breastfeed.

The purpose of this study was to ascertain the baseline food security status of pregnant, first-time WIC participants and to identify any changes in food security status over the course of their pregnancy. We also wanted to determine whether particular aspects of the WIC Program were associated with changes in food security status of participants over time and, if so, what those characteristics might be.

Methods

Participant Recruitment and Data Collection

Women were recruited while enrolling for services at selected centers in...

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